This invention relates to a tubular flexible probe for introduction into the trachea and, respectively, into the bronchial system, containing a continuous first lumen designed for suction with a connecting piece provided at the proximal inlet end for connection to a suction device and, extending therebeside, a second lumen for the administration of media, having a smaller diameter than the first lumen for the suction removal, wherein the wall of the smaller second lumen has a recess in the zone of the proximal inlet end of the probe, wherein an elastic connecting hose is provided for the administration of media, and wherein optionally, in the distal end zone of the probe, at least one penetrating hole is arranged in a wall defining the large lumen toward the outside.
The following steps must be performed in the treatment of patients for respiration and reanimation:
(1) Introduction of irrigation solution into the tracheal and bronchial space.
(2) Suction removal of irrigation solution, mucous, secretions, blood, etc., from the tracheal and bronchial space.
(3) Respiration and, if necessary, oxygen supply.
(4) Furthermore, efforts are being made recently to provide the patient additionally with a direct and fast supply of medicaments to be introduced into the bronchial space.
Heretofore, the following devices have been utilized for the aforementioned treatment:
For steps (1) and (2):
single-lumen suction catheter, as described, for example, in DAS No. 23 64 119 (U.S. Pat. No. 3,848,604), DOS No. 14 91 652 (U.S. Pat. No. 3,375,828) or DOS No. 25 40 536.
For step (3):
double-lumen respirator tube or balloon catheter, as known, for example, from U.S. Pat. No. 4,300,550, DOS No. 28 47 681 and DOS No. 23 08 400.
For step (4):
there is not as yet a suitable device for the introduction of medicaments through the trachea directly deeply into the lung.
When using, for this purpose, the conventional, single-lumen suction catheters (see steps (1) and (2)), then there is the great disadvantage that the medicaments must be introduced only after suctioning through the single lumen. On account of the relatively large diameter of the lumen serving for suction removal of secretions and mucus, medicaments pass only with small proportions into the lung while otherwise remaining in the catheter. Efforts to introduce and distribute the medicaments entirely and deeply into and within the lung are unsuccessful. There is the further drawback that the conventional suction catheters are not equipped with attachments for fitting a syringe, which is, however, necessary for administering medicaments in the liquid form.
The conventional respirator tubes utilized for step (3) are likewise unsuitable for introducing medicaments through the trachea to deep into the lung. These known respirator tubes exhibit a relatively large diameter for the air volume and can be introduced only as far as the trachea. With a relatively short length of the respirator tubes, the introduced medicaments would be held up already on the way to the lungs. The desired introduction and distribution of medicaments to deeply into the lung is impossible.
The endotracheal respirator tube according to DOS No. 23 08 400 comprises a distal beveled, sharp-edged tip which would lead to considerable injuries to the bronchial system and therefore cannot be introduced as far as the bronchi.
In the respirator tube according to DOS No. 23 08 400, suction is also to be possible in addition to respiration; for this purpose, a hose is extended through the tube coaxially as a catheter which reduces and impedes the tube cross section. Also, the hose is loosely suspended in the large lumen of the respirator tube and protrudes from the end whereby no control can be exerted on its position. Using this respirator tube, suction can only be performed intermittently during expiration. Irrigation and simultaneous suction removal of secretions is impossible with the respirator tube according to DOS No. 23 08 400 since, with the irrigation fluid being supplied via the catheter, suction would have to be effected via the tube; in such a case, the respirator tube would adhere by suction to the bifurcation, resulting in diffuse, gravest hemorrhaging with great danger to life. The necessary respiration and, respectively, oxygen exchange can then not be performed simultaneously during irrigation and suctioning. This respirator tube thus is likewise entirely unsuitable for the introduction of medicaments deeply into the lung.
Similar conditions are encountered with the endotracheal respirator tube according to DOS No. 28 47 681 which, on account of its large diameter for air exchange (respiration), the shortness of the tube, and the beveled, sharp-edged distal end, cannot be introduced to deeply into the bronchial system and therefore is not suited for the administration of medicaments to be distributed in the lung. Insofar as the supply hoses for additional oxygen feed are arranged within the large lumen of the tube, they actually do not impede respiration and air exchange--however, suction removal of secretions is no longer possible with this tube.
The endotracheal respirator tube known from U.S. Pat. No. 4,300,550 contains a continuous, large lumen for suctioning air, the proximal end of this lumen being connected to a vacuum device. For the simultaneous feeding of oxygen, the respirator tube contains a second, smaller lumen extending therebeside, the distal end or, respectively, distal outlet openings of which are provided far upstream of the distal end of the tube so that the exiting oxygen is conducted on the outside along the distal tube region.
This endotracheal respirator tube according to U.S. Pat. No. 4,300,550 likewise proves to be unsuitable for the administration of medicaments to deeply into the lung. The large respirator lumen is not suited, because the medicaments get stuck without flow pressure; in case of the small lumen, in contrast thereto, the medicaments get caught in the outlet zone between the tube and the trachea and also do not pass on to the desired site on account of the shortness of the respirator tube.
Furthermore, double-lumen drainage catheters have become known from wound treatment, equipped with relatively large outer diameters for a high suction volume, a relatively short length, and a beveled tip, as disclosed, for example, in French Patent No. 2,454,308. In order to ensure adequate suction, these drainage catheters also exhibit additionally holes providing connection to the outside air in the proximal region of the large lumen. Such drainage catheters which, in their use, are placed and handled visually--i.e., with eye control--are completely unsuited for use in the endotracheal or endobronchial regions. Their type of structure would immediately lead to tissue damage.
The invention is based on the object of providing a probe or catheter usable for introducing medicaments in the liquid form through the trachea and, respectively, bronchi to deeply into the bronchial system and, respectively, the lung, namely in conjunction with suction removal of secretions and mucus or the like from the bronchial system.